Aligning Surgical Practice to an Evidence Base – Past, Present and Future?

Abstract

We are experiencing an evolutionary phase in the teaching of orthopaedic surgery. The model of apprenticeship, which has been the foundation for most professions where both knowledge and technical skills need to be taught, continues still. Within this model, the trainer imparts not just the surgical skills of the operating room but the decision-making algorithms that have been formulated through learning, experience, reflection and self-critique. The apprentice learns by emulation and through a cycle of observation – recall – practise under the tutelage of experts. This expert- based training is entrenched in surgery. It has taken a generation for evidence-based practice to become entrenched in modern clinical life. It brought with it – for orthopaedic surgeons at least – new terminology, new concepts and demands for a better understanding of the structure and quality of clinical experiments. It may take another generation for the blend between expertise, patient characteristics and best available evidence to become a default process in clinical work. This return to appreciating the value of expertise in clinical care is not a case of back to expert-based medicine but a real step forward in as much as modern computing abilities and artificial intelligence will allow us to simplify that collation of information for making individualised decisions for individuals, and not adopt a “one size fits all” approach in treatment.